FNP vs. PMHNP: Which Specialty is Better?
Written By: Jennifer Schlette MSN, RN
A family nurse practitioner (FNP) and a psychiatric mental health nurse practitioner (PMHNP) are both advanced practice nurses. They are both capable of assessing, diagnosing, and treating patients across the lifespan. That may lead you to ask the questions, which specialty is better? Is it an FNP or PMHNP? Well, the answer is not so cut and dry. There are differences between FNP and PMHNP that do exist. Let’s examine this further in this article through an in-depth comparison of FNP vs PMHNP.
1. Family Nurse Practitioner (FNP) vs. Psychiatric-Mental Health Nurse Practitioner (PMHNP): Job Duties
Family nurse practitioners and the psychiatric-mental health nurse practitioners do have some similarities in their job duties, but at the same time they also have differences. Both the family nurse practitioner and the psychiatric mental health nurse practitioner are able to assess, diagnose, and treat their patients. Keep in mind the degree to their autonomy will vary by state. The main difference between the FNP and PMHNP lies within the type of patient they are authorized to treat.
The type of patient that falls into the scope of practice of the family nurse practitioner is the patient who is seeking care for a medical or physical ailment such as a sore throat or abdominal pain. Their job duties will include caring for patients who have an acute illness, infection, or injury. In the primary care setting, these advanced practice nurses are also capable of performing physical examinations. The family nurse practitioner’s education and training has equipped them with the knowledge and skills that are essential to perform their job duties.
The psychiatric mental health nurse practitioner possesses the education and training that has enabled them to perform their job duties to care for those who have a psychiatric or psychological illness. These practitioners are more suited to treat patients who require a higher level of care, have a complicated disease, or have symptoms that have not reduced in severity in a timely manner. The psychiatric-mental health nurse practitioner is charged with the job duty of psychotherapy for their patients as well as diagnosing them on the DSM5. The family nurse practitioner is not authorized to perform either.
So, what are the job duties of the Family Nurse Practitioner vs Psychiatric Mental Health Nurse Practitioner in a nutshell? Keep in mind that both disciplines care for patients across the lifespan or from birth to geriatrics.
| FNP|| PMHNP|
| Assess|| Assessing|
| Diagnose|| Diagnosis on the DSM5|
| Order and interpret test and labs|| Ordering and interpreting test and labs|
| Pharmacological and non-pharmacological treatments under physician guidance depending on the state|| Pharmacological and non-pharmacological therapy including psychotherapy|
| Counseling and educating patients|| Counseling and education|
| Works with patients with physical complaints|| Works with patients with psychiatric or mental health disorders.|
2. Essential Skills Required to Succeed in Your Career
Family nurse practitioners and the psychiatric mental health nurse practitioners share many of the same essential skills to succeed. For both career paths, you will need the critical skill of the ability to listen. Listening to your patient, whether you are an FNP or PMHNP, will help you best treat your patient. Another essential skill both career paths need is to be able to work well with other disciplines. In some instances, to best care for a patient, you will need to collaborate with others. Excellent analytical skills are essential to think critically and to be confident in the decisions you make for your patients. Core competencies are critical and are a foundation for the vital skills that drive the family nurse practitioner and the psychiatric mental health nurse practitioner.
3. FNP vs. PMHNP: What Education is Required to Become?
So, let’s now explore the differences between FNP and PMHNP in terms of what education is needed.
The family nurse practitioner and the psychiatric mental health nurse practitioner tracks, both require that you achieve an advanced practice degree in nursing. To accomplish an advanced practice degree in nursing, you, as the registered nurse, would need to complete a graduate degree or higher in your desired field of study. Once this degree is obtained from an accredited MSN or doctoral nursing program, you must successfully pass an exam designed explicitly for your discipline as the advanced practice nurse. Also, if you are a registered nurse who already holds a Master of Science in nursing degree, you can complete a post-master’s certificate with either the FNP or PMHNP specialization and become a family nurse practitioner or psychiatric nurse practitioner. This post-master’s certificate will give you the credit for graduate courses that you have already taken which can be applied to the family nurse practitioner or the psychiatric mental health nurse practitioner programs. Now let’s dive a bit deeper into the education requirements for these two degrees.
General advance practice courses:
Both degrees require you to complete some version of the following general advance practice courses:
- Advance physical health assessment
- Advanced pathophysiology
- Advanced pharmacology
- Advance health promotion and maintenance
- Health promotion and maintenance
- Healthcare policy
- Advanced research
- Advanced theory
Specialization specific courses:
Depending on the school curriculum you are attending for your graduate degree, some of the courses may be slightly different. Also, each discipline includes a hands-on clinical hour portion within these following courses:
For the FNP core classes include:
- Primary health care for the adult/gerontology client
- Primary health care of the pediatric client
- Advance practicum
For the PMHNP core classes include:
- Advance assessment in psychiatric-mental health nursing
- Psychiatric-mental health nursing across the lifespan
- Individual and family psychotherapy
4. How Long Does It Take to Become?
One of the most pertinent questions on the mind of anybody who wants to become either an FNP or PMHNP is how long will it take? Notwithstanding the several other differences between the FNP and PMHNP track, when it comes to the duration of the program there is quite a bit of similarity. Both programs typically take anywhere from 2 to 7 years, depending on whether you choose to complete an MSN or DNP program and if you decide to enroll for the part-time or full-time schedule. You also need to look at if the program offers courses during the summer. A program that offers courses during the summer can cut down the actual time it takes to earn your degree. Also, one significant factor which impacts this timeline is whether you have a Master of Science in nursing degree before starting the FNP or PMHNP courses as you will be able to earn either of the credentials in a shorter amount of time of one year by completing a post-master’s certificate.
5. PMHNP vs. FNP: How Much Does It Cost to Become?
Regardless of whether you decide to pursue the FNP or PNHNP track, your education could be expensive. The total cost of the family nurse practitioner degree could be anywhere from 15,000 to 250,000 dollars. The psychiatric mental health nurse practitioner program can cost anywhere from 17,000 to 255,000 dollars.
One factor that plays a role in the cost of your education will be if you live in the state that you will be attending school. Many colleges offer discounts for in-state residents. Also, inquire if the institution you currently work for has a program that will reimburse you for your education in exchange for a promise that you will work for them for a set amount of time.
6. PMHNP vs. FNP: Certification & Licensure Requirements
Family nurse practitioners and the psychiatric mental health nurse practitioners will have specific certification and license requirements. Since the state regulates the practice of nursing, each state will have different rules and regulations when it comes to allowing a nurse practitioner to work, as well as the amount of autonomy the advance practice nurse will have. In general, you must hold an active RN license because this is a prerequisite to the advanced practice nurse licensure. The advanced practice nurse's credentials once completed will allow the registered nurse’s license to be upgraded to the advanced practice nurse's license. Keep in mind there are differences between the FNP and PMHNP when comes to the accrediting certifying bodies that offer the certification exam which you must pass to obtain your advanced practice nurse’s license.
The family nurse practitioner must complete an exam from one of the accredited certifying bodies such as the American Academy of Nurse Practitioners Certification Board (AANPCB)
or the American Nurses Credentialing Center (ANCC)
to become certified. Now, suppose you further want to specialize in a particular area of study, in that case, this may require you to have additional hours of education and training and take an additional certification exam. Some areas that a family nurse practitioner can specialize in are oncology or cardiology, to name a few.
The psychiatric mental health nurse practitioner is required to take a certification exam to become board certified. The American Nurses Credentialing Center (ANCC)
offers candidates who have completed their required graduate coursework to sit for the exam. Additional psychiatric-mental health coursework is needed to further specialize in the field of pediatrics in order to become certified to work with children.
7. FNP vs. PMHNP: How Many Nurse Practitioners are Currently Working in This Specialty?
As you can see from the chart below, there is a big difference between FNP and PMHNP in terms of how many are currently working within the profession. One can speculate on the many reasons why there is a huge number of FNPs vs PMHNPs currently working in the nation. One main reason could be that the family nurse practitioner is not as specific in practice as the psychiatric mental health nurse practitioner and hence can widen career avenues. Secondly, there seems to be more choice in terms of different disciplines and concentrations that can be pursued by an FNP vs PMHNP.
| Occupation|| Percent|
| FNP|| 65.40% |
| PMHNP|| 1.80%|
8. Where Do they Practice?
Whether you are an FNP or PMHNP, you can work in many different settings. Some of these settings will be impacted by state regulations regarding if the practitioner can work in private practice or not.
The family nurse practitioner’s training and education has prepared them to function as the primary care provider in many different settings. The psychiatric mental health nurse practitioner is also educated and trained to work in many different healthcare environments. Both these NPs can choose to work in inpatient such as a hospital or as an outpatient as in a clinic. When a practitioner wants to work in the inpatient setting, they have many different units that they can choose from within the hospital, for example, an oncology unit or an emergency department. The outpatient setting may present these practitioners with environments such as working in private practice offices or urgent care, to name a few. Regardless of where these practitioners choose to work, both the family nurse practitioner and the psychiatric mental health nurse practitioner may often find themselves working together or in collaboration to best care for the patient. Sometimes, a patient may require the expertise of family nurse practitioner for a physical ailment and a psychiatric mental health nurse practitioner's knowledge to treat a congruent psychiatric or psychological disorder.
9. Work Hours
The work hours for the FNP or the PMHNP will vary depending on the type of setting they choose to work. If either of these professions want to work in the outpatient setting, then hours of work are typically a 5 day a week 9-5 situation. In some cases, the practitioner may be required to rotate on-call schedules with other providers so that weekends and nights are covered for patients. In the hospital setting, although some practitioners could have a Monday through Friday schedule 9-5, other types of schedules are possible. The practitioners may be required to work a 12-hour day or night with weekends and holidays. This type of schedule is usually completed on a rotating basis. This does not mean you are going to be working 12 hours every day. This means that you will typically be working 13 days a month, 12-hour shifts. Some institutions will either have the practitioner working nights or strictly a day schedule, where others have their practitioners rotate.
10. Work Stress
As an FNP you may find yourself working in critical care or the emergency department which is a high stress environment. These patients can be extremely ill and require a high degree of critical thinking in order to save their lives. An example of high stress that the psychiatric mental health nurse practitioner may encounter in the work environment is when they are asked to consult on patients in the emergency room. Some of these patients can be extremely emotionally or psychologically in need of help. Working in a stressful job situation is, once again, a personal choice. This is up to you.
11. Job Satisfaction
Job satisfaction is personal and different for every person. Sure, many things go into the overall job satisfaction in a place of employment such as respect, quality of life, fair policies and procedures, and appreciation, to name a few. When speaking of health care, many people find that their ability to help others provides them with such a great sense of job satisfaction and that is all they need. When you assume the role of the family nurse practitioner or the psychiatric mental health nurse practitioner, you have the opportunity to provide people throughout the lifespan who are in many different places in their life the optimum care they are seeking. You will see people at their best and at their worst. You will see whichever path you choose that job satisfaction can come from just knowing you were there when somebody was at one of their most vulnerable moments. You need to decide what are the essential qualities that would keep you satisfied in a job. Like I said, it is personal.
12. FNP vs. PMHNP: Job Outlook
According to the Bureau of Labor Statistics, a family nurse practitioner's job outlook places them in a place where they will be in demand. As per the Bureau of Labor Statistics in 2018 there were 189,100 nurse practitioner jobs. This number is projected to increase significantly by 53,300 by the time 2028 rolls around. One key factor contributing to the demand for FNPs is that the baby boomers are beginning to age. The elderly is also living longer these days, this is all in thanks to modern medicine. Therefore, such is a need for preventative care, that can be managed by an FNP as well as the co-morbidities that accompany the aging population. Another factor is that according to a report by the Association of American Medical Colleges, there will be a shortage of 54,100 to 139,000 physicians in the United States by the year 2033
. This shortage creates the perfect job opportunities for advanced practice nurses such as FNPs.
In the specialized field of mental health, there is an ongoing shortage of mental health providers such as a psychiatrist. This shortage will open the door for many people who are interested in becoming a psychiatric mental health nurse practitioner. In the same study by the Association of American Medical Colleges, it is predicted that by the year 2033, there will be a shortage of 41,900 specialty physicians, including psychiatrists
. As the world is ever-changing and becoming more sophisticated which in itself poses its own problems to the mental health of the society, to add to that we must now endure the distress caused by the COVID 19 pandemic. This unsettled world has created a huge need for the psychiatric mental health nurse practitioners, much more than ever before.
13. PMHNP vs. FNP: Starting Salary
Although the starting salaries between the FNP and PMHNP seem pretty comparable, the increase in pay that the PMHNP makes may persuade you to choose one career path over the other. Keep in mind while looking at these numbers, that this is just the starting salary. Both the FNP and PHMNP have much more earning potential as time goes on.
| Occupation|| Hourly|| Monthly|| Annual|
14. Average Hourly Pay
The average hourly pay for the FNP is $46.22, while the PMHNP earns around $53 per hour. These numbers are a reflection of the national average for these two job fields. Things that will affect your hourly pay rate are what state you are working in, if you are in a specialty, and the setting in which you are working. The average hourly pay for the PMHNP is higher than that of the FNP.
| Occupation|| Hourly Pay|
15. FNP vs. PMHNP: Average Annual Salary
The average annual salary of an FNP vs PMHNP is mentioned below. Once again, these figures do not account for specialty or experience. These numbers are based upon the national average annual salary. When you obtain an advanced practice nursing degree, you can expect to make an excellent living. The average yearly salary for the FNP is around $96,200, which is slightly higher than that of the PMHNP at approximately $110,000 per year.
| Occupation|| Annual Salary|
| FNP|| $96,139 |
| PMHNP||$109,927 |
16. Salary by Level of Experience
The FNP and PMHNP both have excellent earning potential throughout their career. However, there is a more significant earning potential for the PMHNP when comparing the FNP vs PMHNP salary over the course of 20 or more years. The FNP can expect to be earning a salary of around $70,000 at the beginning of their career to almost $131,000 with 20 or more years’ experience. The PMHNP also has the potential for growth in terms of salary when comparing the entry-level wage of around $80,000 to around $149,600 by gaining 20 years' experience.
| Occupation|| Level of Experience|| Hourly|| Monthly|| Annual|
| FNP|| Starting (Entry-Level)|| $33.64|| $5,830|| $69,980|
| 1-4 Years of Experience|| $38.35|| $6,650|| $79,760|
| 5-9 Years of Experience|| $45.38|| $7,870|| $94,400|
| 10-19 Years of Experience|| $52.50|| $9,100|| $109,200|
| 20 Years or More Experience|| $62.88|| $10,900|| $130,800|
| PMHNP|| Starting (Entry-Level)|| $38.47|| $6,670|| $80,020|
| 1-4 Years of Experience|| $43.85|| $7,600|| $91,200|
| 5-9 Years of Experience|| $51.89|| $9,000|| $107,940|
| 10-19 Years of Experience|| $60.03|| $10,410|| $124,860|
| 20 Years or More Experience|| $71.90|| $12,460|| $149,560|
The Bottom Line
Family nurse practitioners and psychiatric mental health nurse practitioners are two highly skilled advanced practice nurses who play a pivotal role in our health care system. Although they have similar paths in education to an extent, they both have very different core concepts. There are a lot of factors to be considered when choosing one over the other. Educate yourself on all there is to know about FNP vs PMHNP. Remember you need to do what makes you happy, not what makes others happy, and the good thing for you is, is that this is your ultimate choice.
Jennifer Schlette MSN, RN
Jennifer Schlette is a registered nurse in pediatric critical care in New York City. She is the former Director of Undergraduate Nursing at a college located in New York. After obtaining her BSN from the College of Mount Saint Vincent, she went on to complete her MSN.